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Laser ablation works best for varicose veins

Endovenous laser ablation has been rated as the most successful and cost-effective treatment for varicose veins over surgery and sclerotherapy, according to recent research.

In a UK randomised controlled trial involving almost 800 patients, researchers analysed quality of life questionnaires completed by trial participants five years after having their varicose veins treated via one of these methods.

“This large, multicentre trial … showed that in all three groups, quality of life five years after treatment was improved from baseline,” the study  authors wrote in The New England Journal of Medicine.

But there were important differences between the groups.

In particular disease-specific quality of life measures favoured laser ablation and surgery over foam sclerotherapy. And when the chance of being cost-effective was added into the calculation, laser ablation came out on top.

Unsurprisingly the quality of life scores closely correlated with whether the varicose veins had persisted or recurred at the five year mark.

“The differences in quality of life observed in our study are likely to relate to the fact that the presence and extent of varicose veins at five years were less in the laser ablation and surgery groups than in the foam sclerotherapy group,” the study authors wrote.

After five years, 58% of patients who had had their varicose veins treated with laser ablation reported having no varicose veins. This compared with 54% of patients who had received surgery and 47% who had received sclerotherapy for their veins.

Over the duration of the trial a number of participants had undergone further treatment via the same modality – 11% in the laser ablation group, 14% in the sclerotherapy group and only 7% in the surgical treatment group.

Where the laser ablation really has the advantage over surgery is the fact that the treatment doesn’t require a hospital admission, it can be done under local anaesthetic and the patient is free to walk after the procedure. Very little down time, and not having to take as much time off work certainly contributed to the perceived cost-effectiveness.

Authors of this study known as the ‘Comparison of Laser, Surgery and Foam Sclerotherapy’ (CLASS) trial concluded “laser ablation was similar to surgery with respect to quality of life and of the three treatments had the highest chance of being cost-effective.”

Reference

Brittenden J, Cooper D, Dimitrova M, Scotland G, Cotton SC, Elders A, et al. N Engl J Med. 2019 Sep 5; 381(10): 912-22. DOI: 10.1056/NEJMoa1805186